Black Water Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

BLACK WATER LAB LLC

Practice address

4150 Old Sterlington Rd Ste C
Monroe, LA 71203-2670

Phone

(318) 410-9900

NPI assigned

Feb 8, 2019

Last updated

Feb 22, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Fluitt

Title

Office Manager

Phone

(318) 410-9900

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550793600000",
    "number": "1366907701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 OLD STERLINGTON RD STE C",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 OLD STERLINGTON RD STE C",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032670",
            "telephone_number": "318-410-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK WATER LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-22",
        "status": "A",
        "authorized_official_last_name": "FLUITT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-410-9900"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Monroe, LA
• Providers in Monroe, LA by specialty
• Clinical Medical Laboratory in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.